Provider First Line Business Practice Location Address:
250 E ANTELOPE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WOODLAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93286-1585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-564-7177
Provider Business Practice Location Address Fax Number:
559-564-7104
Provider Enumeration Date:
02/26/2007